Estimation of risk factors, clinical-biochemical and hemodynamic particularities in children with hypertension

Mihai Popovicidoctor habilitat, professor, Medical-Sanitary Public Institution Institute of Cardiology Ninel Revencodoctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Purpose of the paper: The assessment of the clinical-biochemical and haemodynamic
peculiarities, the impact of various risk factors present in hypertensive children according to body
weight.

Objectives of the paper: Estimation of risk factors in the occurrence of hypertension (HT) in
children; assessment of clinical-hemodynamic peculiarities of HT in children; assessment of lipid-
specific, glucose spectrum specifics of chronic inflammation markers (hs, α-TNF) and adipokine
(adiponectin, leptin) in hypertensive children and body weight; estimating the role of homocysteine
as a marker of endothelial dysfunction; the assessment of catecholamines as markers of sympathetic
nervous system involvement in pathogenic links of HT and obesity in children, as well as assessment
of subclinical organ damage (assessment of microalbuminuria, left ventricular myocardium mass
index, carotid artery intima thickness) in children with hypertension.

Scientific novelty and originality: A case-control study was conducted that assessed the impact of
a complex block of risk factors with hypertensive determinism, including the role of
hyperhomocysteinaemia and the deficiency of 25 OH vit D, a higher number of hypertensive
children. The innovative intent is also to estimate the significance of microalbuminuria, the left
ventricular myocardium mass index (LVMMI), the intimate-mean ratio in the common carotid
artery, in their position of early markers of subclinical organ damage in hypertensive children. An
unusual tentative research is testing leptin, serum adiponectin, hs, α-TNF PCR, serum
catecholamines and urine to argue the role of the sympathetic nervous system, pro-inflammatory
adipokines and cytokines in the pathogenetic links of HT and obesity in children.
New results for science and practice obtained: The results, which determined the solution of a
scientific and applicative problem, of major importance, lie in the scientific substantiation of the
new visions on HT risk factors in children (traditional risk factors, hyperhomocysteinemia and
difficulties in diagnosing diabetes, adipokine / cytokines, markers of endothelial dysfunction,
involvement of the sympathetic nervous system and subclinical organ damage), which has
contributed to a broader understanding of the pathophysiological mechanisms of achieving HT in
children and confirmed the appropriateness of their use as early screening biomarkers of HT for the
early application of prophylaxis and treatment measures.

Theoretical significance:
In-depth research on the risk factors, premises, and circumstances involved in the occurrence of
HT in children has substantially completed the vision of a concept upon a phenomenon with multiple
medical and social human implications, such as that of HT initiated at early ontogenetic stages.
Program research in the defining substrate of the affect, such as chronic inflammation markers (CRP
hs, α-TNF), adipokine, hipovitaminosis D - as early markers of HT, hyperhomocistin as a marker
of endothelial dysfunction and catecholamines analyzed as a marker of sympathetic nervous system
(SNS) involvement in the HT pathogenesis have brought new scientific arguments and have finally
suggested clear principles of ordering appropriate activities and measures of effective prophylaxis,
combating risk factors and hypertensive determinism disorders. Monitoring serum levels of 25
hydroxyvitamin D and correction of deficiency at the right time will further optimize cardiovascular
health of the population.

Paper’s applicative value:
By revealing the morbid contribution of the risk factors that the hypertensive children behave or
are exposed to, the programs of prophylactic measures that will be implemented in practice will
optimize the morbidity through HT. The implementation in the pediatric routine of the testing of
adipokines, proinflammatory markers and endothelial dysfunction will contribute to the recognition
of HT at preclinical stages and will suggest early preventative and treatment measures.
Microalbuminuria testing, LVMMI, carotid artery intimate / mean thickness assessment will
complement and sublimate the appropriate (subclinical) diagnosis of subclinical organ damage.Implementation of scientific results:
The results of the study were implemented in the clinical activity of the scientific laboratory of
pediatric cardiology of the PHI Institute of Cardiology, specialized services of the PHI "Valentin
Ignatenco" Municipal Clinical Hospital for Children and the Institute of Endoscopy of the PHI
Mother and Child Institute.